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My husband has had pain in his legs while walking for a couple of years now. The pain stops with rest. Recently he had a MRA that revealed a 13 cm long occlusion in the right superficial femoral artery (SFA), and a 60% localized stenosis of the mid left SFA. He has been referred to a surgeon with recommendations of a right femoral bypass and a balloon angioplasty in the lower left extremity. My husband is 55 years old and overweight, he has high and somewhat unstable blood pressure, high cholesterol, and a recent blood test indicated he was borderline diabetic. His father had two heart attacks and his mother has had two heart surgeries and now has a pacemaker. Over the past couple of years he has developed an involuntary head bob. From everything I have read, all of these factors indicate he is a high risk for heart attack or stroke.
My concern is that there is a blockage other than just his legs, and the MRA of his lower extremity did not tell us the big picture. Will the surgeon do additional testing automatically or do we need to request additional tests. What questions should I ask to ensure that the surgeon looks at the big picture?

Answer:

The symptoms and the MRA results that you describe suggest that your husband has PAD (peripheral arterial disease). In my opinion, you are correct to be concerned about the possibility that your husband has coronary artery disease as well. He has risk factors that raise this concern including his strong family history of cardiovascular disease, his weight condition, his blood tests indicating the possibility of "borderline" diabetes and his high blood pressure.
In my opinion, before a recommendation is made to proceed with a femoral artery bypass, an evaluation by a cardiologist is advisable.